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Dr. Thorn on Heart Disease in Women

Today I will be giving a talk for heart month to the staff of the US Supreme Court. The topic of my talk will be “Women and Heart Disease.” Traditionally, heart disease has been considered a male problem. This has resulted in under awareness, under testing, under detection, and under treatment of heart disease in women. Fortunately, this pattern is changing in recent years, most significantly with an increase in awareness that heart disease is a real problem for women as well as men. I’d like to use this blog post to highlight some of the main points that I will be making in the talk that are important for all women (and men with women they love in their lives!) to know.

1. Heart disease is a serious issue for women.

Contrary to prior misconceptions, heart disease is the #1 killer of American women. More women than men die from cardiovascular disease every year. Heart disease kills more women than all forms of cancer combined. Women have equal or greater rates of angina (symptoms of lack of blood flow to the heart) compared to men. Women who have a heart attack are more likely to die than men with heart attacks.

2. The cause of heart disease in women is the same as in men but with some important differences.

Heart disease in women is caused by atherosclerosis of the coronary arteries. What this means is that a material called plaque builds up in and along the walls of the arteries that carry blood to the heart. If the atherosclerosis is severe enough chest pain can occur (angina.) If a blood clot develops on the plaque and blood flow is blocked, a heart attack can occur. However, women can often have angina even when a blockage is not that severe. This is thought to be due to malfunctioning of the arteries themselves. This means that even when “blockages” are not found, heart disease can cause problems. Women with even mild degrees of narrowing of the coronary arteries are at increased risk and require aggressive prevention measures.

3. Risk factors for heart disease in women are generally the same as those in men.

Traditional risk factors for heart disease include age, abnormal cholesterol, smoking, diabetes, lack of physical activity, excess weight, and family history of heart disease. Almost all women with heart disease will have one of these risk factors. The metabolic syndrome is a major factor in driving heart disease risk in women. The combination of elevated blood pressure, elevated triglycerides, low HDL cholesterol, abnormal blood sugar, excess abdominal fat, and intolerance of carbohydrates leads to a large increase in heart disease risk due to the presence of multiple risk factors.

4. Most women with heart disease will have chest discomfort. However, women are more likely to have less typical symptoms of heart disease.

The most common presenting symptom of heart disease in women is chest pain or discomfort. However, this pain in women is more often precipitated by mental or emotional stress. Pain with physical activity is less common than in men. Women are more likely to have associated stomach discomfort or nausea. Chest discomfort in women is more likely to extend to the arms, shoulder blades, neck, or jaw.

5. It is critical to recognize possible heart symptoms early and act quickly.

Because of historic misperceptions that heart disease was not a problem in women as well as the fact that symptoms in women can be less typical, women present for treatment later than men. additionally and sadly, delays in ambulance and doctor response times have been reported. Therefore, it is critical to recognize that any new or different chest discomfort can represent a heart attack. In this event, call 9-1-1 immediately. Do not drive yourself to the hospital. A false alarm is a much better outcome than having a true heart attack and not seeking help.

Remember, heart disease is treatable and preventable in women and men. If you have concerns, talk to your doctor and have them addressed. Put a plan for prevention in place, starting with lifestyle changes including a healthy diet and regular physical activity.

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